How the Public Option works in Britain

This, from the London Times:

DAMNING reports on the state of the National Health Service, suppressed by the government, reveal how patients' needs have been neglected.

They diagnose a blind pursuit of political and managerial targets as the root cause of a string of hospital scandals that have cost thousands of lives.

The harsh verdict on the state of the NHS, after a spending splurge under Labour between 2000 and 2008, raises worrying questions about the future quality of the health service as budgets are squeezed.

One report, based on the advice of almost 200 top managers and doctors, says hospitals ignored basic hygiene to cram in patients to meet waiting-time targets.

Notice that bit about a "spending splurge." The Labor Government increased spending on the NHS, and at that very time, the NHS was ignoring "basic hygiene." This, apparently, costs thousands of lives.

Just something to think about, as the Obama Administration and the leadership of Congress prepare to turn the entire American health care system over to the Department of Health and Human Services.

Comments

[A.I.]

C'mon KB, just because I haven't posted for awhile doesn't mean you can pass off just anything as a reasonable argument. Were I suspicious by nature, I might think you wrote this post to undermine Democratic efforts at health care reform.

Having written the preceding sentence, I will require medical attention to repair the hole created when my tongue pierced my cheek. If that involves hospital admission, I may join the 48,000 who die annually from infections contracted in American hospitals or the 300,000 who become ill but recover or the uncounted (likely thousands more) who develop symptoms after discharge. Thus hospital-acquired infections are hardly unique to the NHS and are all to common in the U.S. despite our "spending splurge" (double over the past decade) on private health insurance.

Nor is it reasonable to conflate a proposed "public option" in the U.S. with the British system. The public option would simply be one other type of insurance that a limited number of Americans would be able to purchase to cover costs incurred when accessing privately-provided medical care. That's a far cry from the totally public NHS which encompasses both payment for services and the service providers. Which is to say, nothing currently proposed would "turn the entire American health care system over to the Department of Health and Human Services." And even if it did, nothing you've said here proves that would necessarily be a bad thing when compared to the status quo.

[KB]

A.I., old friend! I missed you dearly. If this post served to rekindle your affection, then it has done its work.

To be sure, American hospitals have their problems. However,the point of these stories is not just that people are dieing needlessly in the British system but that the care they are receiving is often appallingly bad. A man in a British hospital recently called the police because he was literally dieing of thirst and could get no help from the hospital staff. The police arrived and were told everything was in order. The bobbies left and the man perished. What the NHS stories show is that a national health service is no cure for those problems.

I have long thought it revealing that the current push for healthcare reform didn't include a lot of searching studies of European systems. I have heard that the French system is pretty good, combining the best parts of private and public systems. I have heard something similar about the Swiss system. At this point we ought to know as much about these systems as we do about the filibuster, but in fact there has been little such discussion. I think the reason is simple. The Democrats did not set out to make the American system better. They set out to get national health care.

You are certainly right that the healthcare proposals (so far there is not yet a real bill) being put forward do not create a NHS for America. They would in fact create a system in which government bureaucrats decide what procedures will be covered by health insurance, how much policies will cost and what their benefits will be, and what persons will be covered (pretty much everyone, like it or not, except illegal aliens). Apart from deciding how big their deductible will be, everyone will have the same health insurance. That looks like government controlled healthcare to me.

A.I.: I am not arguing that the status quo is better than reform. I am pretty sure that it's better than any reform on the table. Everything about this process suggests that Congress is unwilling and/or unable to take an honest look at the matter. It is certainly unwilling to make any hard choices.

thanks for the post.

[George Mason]

A couple of years ago I was seated next to a Nephrologist on a flight. She related that she had recently attended a seminar in France. She told me that in the French medical system if you are over 60 and require dialysis you will not receive it. They have limited facilities and are not going to spend the money to expand this service. The approach is that 60 years is long enough and if your kidneys fail you will drift off into a coma and die. A not unpleasant death. This is one of the areas and one of the methods for rationing health care. All socialized systems ration care. The rationing is most acute for people over 60. Whether dialysis, joint replacement, heart surgeries, etc. this is the socialized medicine equivalent of the eskimo's putting the old toothless man on the iceberg. This is what Sarah palin was describing as "Death Panels."

[A.I.]

George: You just can't believe everything said by someone sitting next to you on a plane. This study may be of interest to you: http://ndt.oxfordjournals.org/cgi/content/full/20/11/2446 Note a line in the first paragraph of the discussion section: "In France, patients over 60 currently constitute over half of those requiring dialysis, though they constitute only a quarter of the French population." In fact, as I read certain passages in this study, it appears French nephrologists are more likely to force treatment on a patient wishing to stop dialysis than are their U.S. peers.

KB: You misrepresent what is proposed for the U.S. The bills set minimum standards for policies sold through the "exchanges". That does not mean certain policies can not exceed those standards or that prices will be rigidly controlled.

As for the man dying of thirst, there seem to be some extenuating circumstances involved that may, upon full investigation, relegate this story to little more than urban myth. But even if mostly true, it is not an indictment of what is proposed here as comparing what the right so endearingly refers to a "Obamacare" to the NHS is tantamount to comparing apples and walnuts.

And by the by, how about our system under which Doctors occasionally amputate the wrong limb or operate on the wrong patient? Shall we blame that on fee for service? It seems as logical as blaming every problem in the NHS on socialism.

[Guard]

All you guys talk about is pretty pointless now. The reality of what's going on is out of your control.

[George Mason]

A.I. old boy, you may have the beginning of a refutation there but you have a ways to go. This is a survey of some doctors biases in a confined geographical area. It is not a study of national policy or its implementation and consequences. You need a broad nationwide survey for that. We look forward to your expanded research. Be advised that you need to take into account, as evident in the studies of the "French Paradox", that the French have a unique method of keeping medical records. This demonstrates either a profound lack of curiosity or an institutional effort to cover up their inadequacies. Good hunting.

[A.I.]

So George, how is it that a study of factors which would cause denial of treatment to people 60 and over could be conducted in any part of a country your source says denies all treatment to that age group. I didn't see evidence that the study was a hypothetical. People receive treatment except in extreme circumstances. And if some receive treatment in any part of France, it is impossible to say none receive treatment in all of France. Which is to say, don't take the word of just any Tom, Dick or nephrologist regarding French health care.